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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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1/2022
vol. 14
 
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abstract:
Original paper

Advantages of TRUS-based delineation for high-dose-rate prostate brachytherapy planning

Heloise Lavoie-Gagnon
1
,
Andre-Guy Martin
1, 2
,
Eric Poulin
1
,
Louis Archambault
1, 2
,
Laurie Pilote
3
,
William Foster
1
,
Eric Vigneault
1, 2
,
Damien Carignan
1, 2
,
Frederic Lacroix
1

  1. Département de Radio-Oncologie, CHU de Québec Université Laval, Québec, Canada
  2. Centre de Recherche CHU de Québec Université Laval, Québec, Canada
  3. Département de Radio-Oncologie, Hôtel-Dieu de Lévis, Lévis, Canada
J Contemp Brachytherapy 2022; 14, 1: 1–6
DOI: https://doi.org/10.5114/jcb.2022.113544
Online publish date: 2022/02/18
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Purpose
To evaluate the variability of prostate contours delineated on computed tomography (CT) and transrectal ultrasound (TRUS).

Material and methods
A TRUS-based high-dose-rate (HDR) brachytherapy procedure was introduced in 2016 in our center. The first thirty patients were additionally imaged with CT immediately after the treatment. In 2018, four different radiation oncologists (ROs: 1, 2, 3, 4) contoured the prostate on both modalities. A volume comparison was performed between CT and TRUS imaging. Using prostate gold fiducial makers, a rigid registration between CT and TRUS was done in 20 of the 30 patients studied. Jaccard index (JI) was computed to evaluate the inter-observer volume delineation agreement.

Results
The ratio of TRUS/CT volumes was 0.82 (95% CI: 0.79-0.87%). The mean JI was 87% for CT and 92% for TRUS, when comparing all four ROs; CT and TRUS JIs were significantly different (p < 0.001). The mean JI for the prostate on CT was significantly more consistent (p < 0.001) when comparing RO1, 2, and 3 together (RO1-2, RO1-3, and RO2-3; mean = 89%) than when comparing RO4 (newest to clinical practice) to others (RO1-4, RO2-4, and RO3-4; mean = 85%). For TRUS planning, the mean JI was not significantly different (p > 0.05) when comparing all ROs.

Conclusions
The inter-observer and intra-observer variability were statistically significantly smaller on TRUS compared to CT-based planning, despite varying ROs clinical experiences. The superior soft tissue contrast offered by TRUS obviates the effect of the ROs experience on prostate contour volumes and enables more reproducible prostate delineation.

keywords:

brachytherapy, prostate cancer, delineation, registration, ultrasound, high-dose-rate

  
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